2019 OPEN ENROLLMENT ENDS (most states)

I've already taken apart Heritage Foundation shill Sharyll Attkisson for her mind-bogglingly embarrassing FAIL at trying to claim that the uninsured total has only dropped by 3.4 million since the ACA exchanges and ACA Medicaid expansion kicked in on January 1st, when in fact it's actually around 12 million, give or take...a number which has been proven by surveys by not just one, not two, but five well-respected sources, including Gallup, the Urban Institute, the RAND Corporation, the Commonwealth Fund and the New England Journal of Medicine.

Now, it seems, I'm going to have to tackle the Heritage Foundation itself directly. A couple of days ago they released a study which claims that (here's the Abstract)...

Thanks to contributor Britt M. for pointing me towards an interesting development in the other Federal Tax Subsidy case (ie, the one not named "Halbig"). As you'll recall, last week the DC Circuit Court panel ruled in favor of the plaintiff in the Halbig v. Burwell case, but the same day, the 4th Circuit Court panel ruled in favor of the HHS Dept. on an almost identical case (King v. Burwell).

It was expected that both cases would then move to the full courts of their respective Circuits (DC for Halbig, the 4th for King). In both cases the Obama administration is heavily favored due to the political makeup of the courts.

However, it looks like the King plaintiffs realized this and decided to cut to the chase, skipping past the full 4th Circuit and pushing straight for the SCOTUS. The Obama administration, meanwhile, wants the full DC Circuit to hear their appeal of the Halbig case...after which whichever side loses will undoubtedly push it up to the SCOTUS as well.

Opponents of Obamacare who lost their legal case over federal subsidies last week are now appealing directly to the Supreme Court, CNBC reported, but it is not clear whether the Supreme Court will take the case.

There hasn't been a real QHP update out of Nevada since they shut down their extension-of-an-extension period at the end of May.At the time, their total enrollment figure was still stuck at 47,245, but their paid number had inched up to an unimpressive 35,700 people.

Today, some 2 months later, it looks like that number still isn't all that impressive (I'm assuming "more than 37K" is around 37,100). Adding insult to injury, all of them will have to re-enroll via HC.gov, although to be honest I kind of figured as much; I'd be very surprised if Oregon isn't facing the same issue, and as I've already noted, it's probably a good idea to have everyone re-enroll anyway just to make sure that they aren't surprised by changes in their tax subsidies:

More than 37,000 Nevadans who signed up for health care plans on the state’s insurance exchange will have to do so again.

The decision is the latest in a series of ongoing changes at the exchange as it tries to recover from a tumultuous first year of signing up consumers for plans that comply with the Affordable Care Act.

This is the third 2015 rate change update today; I had already reported on the 25% drop on one of the companies operating on Mississippi's exchange a few weeks ago, but this makes it official, and also reveals that the 2nd provider (there's only 2 on MS's exchange) is only requesting to raise their rates by 6.5%:

A week or so ago, I posted an entry about the requested rate changes for 2015 from the insurance companies operating on the New York exchange (I'm emphasizing "requested" since, again, those changes still have to be approved by state regulators, who have already lopped the average increases down dramatically in both Rhode Island and Connecticut, and I just announced that CA kept them to a quite reasonable 4.3% (weighted) average). The overall unweighted average requested change in New York appeared to be 14.6% increase, which isn't good news at all.

Thanks to contributor Bob H., however, for not only crunching the numbers to give the properly weighted average increase, but also for noting that it turns out that the number of companies listed in the original report (a whopping 42 of them) is slightly overstated, to put it mildly. You see, it turns out that, according to Bob...

SACRAMENTO, Calif. — The vast majority of Covered California consumers will see low increases in their health insurance premiums for 2015, and many consumers will see no increase or even a decrease. The statewide weighted average[*] came in at 4.2 percent, with some plans offering weighted average rates that are 8.5 percent lower than current pricing.

Taking a little break from the Halbig nonsense to get back to the core purpose of this website...

The Graph is starting to get pretty unwieldy at this point. The scale has been changed from Weekly to Monthly, and things are getting pretty squished horizontally with the addition of August to the right side. The overall range remains somewhere between 23 - 28 million, with the main increases being on the QHP side and minor tweaks (some up, some down) in the Medicaid, SHOP & other areas.

The only other notable change is that I've removed the "depending on payment status" qualifier, since I've already removed the 10% of exchange QHPs who definitely aren't paying up for a variety of reasons.

OK, I've proven time and time again that overall, roughly 90% of ACA exchange QHP enrollees do eventually pay their first month's premiums, although it may take a bit longer for some of them to do so. The problem with the exchanges (or individual insurance companies, or the state insurance commissioners or whomever) releasing a flat "XX% have paid as of such-and-such date" is that it's misleading, since anyone who has enrolled within the past 2 weeks likely won't have their policy actually start for up to a month or longer, and even those who enrolled more than 2 weeks ago may just be starting their coverage now. In other words, it's a rolling average, which increases as time goes on for the earlier enrollees, but drops as time goes on for the newest enrollees.

Finally, a solid update out of Vermont; thanks to Morgan True of VT Digger for pointing me towards the most recent Vermont Health Connect report as of just a week or so ago:

There's a lot going on in the table above. For one thing, this demonstrates, again, how stupid it was to hyperventilate about "How many have PAID???" back in February or March, when a good 40% or more of the people who would eventually enroll wouldn't even have their policies kick in for weeks or even months yet. Note that of those whose policies started between January 1 - May 1st, over 95% have paid their first premiums by now:

There's been a recent batch of insurance rate change requests reported across various states which has gotten a lot of press. However, as I noted a couple of weeks ago, there can be a big difference between what the insurance companies ask for and what the state insurance commissioner approves. This is one of the most important (and least-written about) aspects of the ACA: Insurance companies can no longer just jack up their prices however much they feel like; those rates have to be approved by the insurance commissioner for the state they're operating in if they want to sell their wares on the exchange.

Yesterday I posted an article in which I attempted to coin the term "Halbig Conspiracy!!®" (complete with not one, but two exclamation points). However, others including Kevin Drum of Mother Jones and Brian Beutler of the New Republic prefer the term "Halbig Truthers®", which I have to admit rolls off the tongue better, so I'll go with that instead.

...can point out a conservative who so much as suspected that subsidies were limited to state exchanges prior to March 2010. Surely that's incentive enough? Let's start digging up evidence, people.

This led to a brief Twitter exchange in which Vox's Adrianna McIntyre offered to match Drum's $10, and I upped the ante (um...sort of) by offering up my collection of mint-condition official Todd McFarlane "Spawn" promotional action figures to sweeten the pot (I was a movie theater manager in a prior life and these were left over after the live action movie bombed in 1997).

As of July 6, 9,953 North Dakota residents were covered by private insurance plans obtained through the federal marketplace, up from 8,374 reported at the committee’s last meeting May 14, according to Insurance Department figures.

That’s still lower than the 10,597 enrollment figure cited by the Obama administration in April, in part because the state counts only those who have actually paid their first month’s premium. Either way, enrollment fell short of the administration’s projection that 11,000 North Dakotans would enroll in private plans through the marketplace during its first six months.

Greg Sargent over at the Washington Post has done an excellent job of looking at the reality behind what I'm terming the "Halbig Conspiracy!!®" (note: if you choose to re-post this, I ask you to include both exclamation marks), by looking at the actual history of the federal exchange in the earlier drafts of the ACA bill:

...But documents from the Senate committees that worked on versions of the bill in 2009 — combined with a close look at the history of the phrase itself, and interviews with staffers directly involved in the drafting of the statutes — strongly undercut the argument that the law did not intend or provide subsidies to those on the federal exchange.

...1) The first Senate version of the health law to be passed in 2009 — by the Health, Education, Labor and Pensions Committee — explicitly stated that subsides would go to people on the federally-established exchange. A committee memo describing the bill circulated at the time spelled this out with total clarity.

No, I don't plan on posting Minnesota updates every day, but I'm still amazed that they seem to be having no problems doing so with their (supposedly) "faulty" exchange website, while the HHS Dept (as well as the New York exchange) has made an official policy decision not to post any updates for (presumably) the full 7 month off-season period.

Oregon continues to post impressive enrollment numbers considering their never-working website. Total QHPs are up another 922, Net QHPs are up 185 and Medicaid enrollments are up 12,517 over the past week:

An odd update from the DC exchange...not the update itself, which shows a modest-but-steady increase in QHP enrollment, but the fact that it only runs through July 9th even though it wasn't posted until yesterday (7/28). The prior update ran through July 1st, so that's a net gain of 197 people in 8 days, or about 24 per day. This is actually up slightly from the May/June average of 22/day.

Both the SHOP and Medicaid numbers also went up slightly as well, but again, this only covers an 8 day period:

Monday, July 28, 2014

Enrollment

From October 1, 2013 to July 9, 2014, 51,059 people have enrolled through DC Health Link in private health plans or Medicaid:

12,530 people enrolled in private health plans through the DC Health Link individual and family marketplace.
13,779 people enrolled through the DC Health Link small business marketplace.
24,720 people were determined eligible for Medicaid coverage through DC Health Link.

...After taking political heat for the exchange's technological failure, the appointees of Gov. John Kitzhaber are taking on a more significant role, transforming the agency for the future. At a time when critics of the agency say it should go away, it's the bureaucratic equivalent of an existential moment for an agency considered crucial to federal health reforms.

... The state's planned 2015 partnership with the federal exchange is called a "supported state-based" exchange. But it's supposed to be a temporary fix before setting up a full-fledged state-based exchange. It allows Oregon to keep insurer fees of about 2.5 percent of premiums for itself until the state resurrects its own website.

In any event, while there is indeed a small slowdown which seems to have kicked in since the COBRA extensions dropped out at the end of June, it's now looking more and more as though the huge drop I saw the first week of July was mainly a combination of a data entry error in Hawaii and the long 4th of July weekend in general.

Unfortunately, the full article is locked behind the paywall, but Taegan Goddard's WonkWire reports that "some" of the 36 states being run through HC.gov are taking various measures just in case the Halbig decision is ultimately upheld:

Wall Street Journal: “A number of states are scrambling to show that they—not the federal government—are or will soon be operating their insurance exchanges under the 2010 health law, in light of two court decisions this week.”

“The efforts are aimed at ensuring that millions of consumers who get insurance through the exchanges would be able to retain their federal tax credits if courts ultimately rule against the Obama administration.”

“Amid the uncertainty, some of the 36 states in which the federal government has a role in the exchanges are moving to shore up their status. Some are saying publicly that their exchanges have always been state-operated. Others are trying to make the case that they should be considered to have state exchanges regardless of federal involvement. Still others, such as Arkansas, are pushing ahead to take over their exchanges, which would likely free them from the effects of any court decision.”

Yes, 49 people is pretty tiny even for a state with as low an uninsured population as Hawaii, but it's still further evidence that the drop in QHP enrollments in the first week or so of July was either a typo or a data entry glitch, as the total has since risen for 2 weeks straight. SHOP enrollments haven't changed since 7/15:

While all the fuss & bother over the Halbig case continues to get bopped around by every pundit under the sun (including me? Do I count as a pundit now?), the ACA itself continues to actually, you know, work as another 8,400 people are added to Medicaid via the expansion program here in Michigan:

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 334,599
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of July 21, 2014
*Updated every Monday at 3 p.m.

(Note that this is actually as of a week ago...there should be another update later this afternoon...)

As there are an estimated 500K eligible for the expansion program, this means that Michigan has already reached 2/3 of the total in less than 4 months.

So one important practical question Halbig raises is this: what makes a state exchange a state exchange? If the view of the 2-1 majority in Halbig were to prevail at the Supreme Court (a prospect I’d still consider unlikely, because the reading of the statute is so wildly implausible), then what is the minimum a state can do that counts as a “state exchange” for purposes of receiving the federal subsidies?

Nice find by Esther F. The main focus of the story is that a 5th insurance company has decided to join 4 others on New Mexico's ACA exchange, which is of course good news for competition, the free market and so forth...

The newest insurer is CHRISTUS Health Plan of Texas, Franchini said during a meeting of the NMHIX board in Santa Fe.

“CHRISTUS is a nonprofit and they will be on the exchange. They will be the fifth carrier on the exchange,” Franchini said.

CHRISTUS will join New Mexico Health Connections, Presbyterian Health Plan, Blue Cross and Blue Shield of New Mexico and Molina Healthcare of New Mexico as the firms that will sell in the individual exchange.

...however, Esther notes a potentially far more significant section of the story farther down. The backstory is this: New Mexico has been planning on running their own exchange for the 2nd year of open enrollment, but has more recently been having second thoughts given the various technical issues faced by some of the other state exchanges. Therefore...

So, this morning's big Halbig-related development is that Reason.com has dug up a video of a presentation by MIT economist Jonathan Gruber from January 2012. Gruber was one of the main architects of the health insurance law in Massachusetts (RomneyCare) and the national version (the ACA, aka Obamacare). In his presentation, Gruber states:

What’s important to remember politically about this is if you're a state and you don’t set up an exchange, that means your citizens don't get their tax credits—but your citizens still pay the taxes that support this bill. So you’re essentially saying [to] your citizens you’re going to pay all the taxes to help all the other states in the country. I hope that that's a blatant enough political reality that states will get their act together and realize there are billions of dollars at stake here in setting up these exchanges. But, you know, once again the politics can get ugly around this. [emphasis added]

Some of the various state-run exchanges continue to experience assorted technical issues, ranging from minor to serious. I may be rooting for the ACA to work, but as a website developer and a member of the Reality-Based Community, I do need to fully acknowledge that it's not all sweetness & light on the tech side these days. These issues will be resolved eventually, but you can't just ignore them either. So, without further ado...

Snowballing technological problems at Vermont’s online insurance exchange are drawing new scrutiny. And advocates warn that the situation for many customers who bought plans through Vermont Health Connect is becoming increasingly dire.

OK, with all the fuss about the Halbig decision, people have been flooding me with a bunch of stories about both that as well as other ACA-related topics. I can't address them all fully, so here they are in bite-sized format:

Millions of Americans can expect to get a refund from their insurance companies this year, at an average of about $80 dollars per family, thanks to a little-known Obamacare provision that’s helping people save money on their premiums. According to a new report released by the Health and Human Services Department on Thursday, Americans across the country have received a total of $1.9 billion dollars in rebates since this provision first took effect in 2011.

Normally this would be a lengthy entry, but given that there have already been 4 other major national surveys saying the same thing, the latest news is just locking things down.

The New England Journal of Medicine just published a new report which concludes (shocker) that there's been a net reduction in the number of uninsured U.S. adults by around 10.3 million since the ACA exchanges went into effect:

As compared with the baseline trend, the uninsured rate declined by 5.2 percentage points by the second quarter of 2014, a 26% relative decline from the 2012–2013 period. Combined with 2014 Census estimates of 198 million adults 18 to 64 years of age,19 this corresponds to 10.3 million adults gaining coverage, although depending on the model and confidence intervals, our sensitivity analyses imply a wide range from 7.3 to 17.2 million adults.

OK, I've had a chance to download the actual Excel file with the raw data and a handy graph already set up; I've cleaned up and color-coded the graph, and it's fascinating to look at, both during open enrollment as well as since it ended The things which stand out the most:

The obvious dead zone in October and most of November, finally coming to live around Thanksgiving time

The gradual rise in December, culminating in a large spike on Christmas Eve (the "official" deadline for January 1st coverage, although that varied in some states)

The massive spike in late March, culminating in a nearly off-the-chart peak on the "official" open enrollment deadline of March 31st, which saw over 200,000 transactions by itself

Yes, I'm quoted in this breaking story; Mr. Ornstein contacted me earlier today to ask my thoughts on his scoop, and I agreed to keep mum until it went public:

For months, journalists and politicians fixated on the number of people signing up for health insurance through the federal exchange created as part of the Affordable Care Act. It turned out that more than 5 million people signed up using Healthcare.gov by April 19, the end of the open-enrollment period.

But perhaps more surprising is that, according to federal data released Wednesday to ProPublica, there have been nearly 1 million transactions on the exchange since then. People are allowed to sign up and switch plans after certain life events, such as job changes, moves, the birth of a baby, marriages and divorces.

Now, before everyone jumps on the "1 million" figure, a few important things:

When I posted my dumb-simple solution/workaround to resolve the Halbig decision back on July 2nd (assuming that it's upheld, which is by no means guaranteed), I meant it seriously, but figured that no one else would. I mean, really...the salvation of the most important healthcare law of the past 50 years and the single most important accomplishment of the Obama administration could end up being as simple as registering 3 dozen domain names and putting up a splashpage?

For months, the state has labored under the largest such pile-up in the country, with 900,000 pending cases reported in May—the combined result of unexpectedly high application numbers and bug-ridden computer systems.

Regular readers of this site know that I have a checkered history with Forbes writer Chris Conover. It's been mostly on the hostile side, but he's also occasionally brought up a valid point which I've incorporated into my estimates; in particular, the "Sub26er" estimate has been changed from a flat 3.1 million to a range between 1.6 - 3.1 million in part due to his information (as well as Glenn Kesslers'). I believe the term which applies on both of our parts is "grudging respect" though I could be wrong at his end.

Thanks to the Washington Post's Greg Sargent for the heads up on a new national CNN poll about the ACA. Here's the key findings...and kudos to CNN for clearly distinguishing between those who oppose it for being "too liberal" (which basically means they don't like Medicaid expansion and tax subsidies) and those who oppose it because they want Single Payer (which includes myself, although that doesn't mean I oppose the law, since I see it as a path towards single payer):

According to the poll, only 18% of the public say they or their families are better off now that the major provisions of the health care law have been implemented. Another 35% report that, while their lives have not improved, the Affordable Care Act has benefited other people in the U.S. Add those two numbers together, and that means 53% say that Obamacare has helped either their families or others across the country.

OK, that may seem like an awkward way of shoehorning the Halbig decision into what's otherwise a simple state-level enrollment update entry, but the two are joined at the hip, since the state in question (Arkansas) happens to be one of those being run through Healthcare.gov:

A total of 185,000 persons have enrolled in expanded Medicaid and another 40,000 have bought insurance in the Obamacare exchange—together nearly half of all the previously uninsured citizens in Arkansas. When the new governor takes office, some 215,000 will be enrolled in expanded Medicaid alone. Will Hutchinson and, indeed, most Republican legislators want to end medical coverage for so many of their neighbors and constituents?

President Obama’s healthcare law was dealt a new blow Tuesday as a federal appeals court ruled that due to a wording glitch in the Affordable Care Act, some low- and middle-income residents are not entitled to receive government assistance to subsidize their insurance.

In a 2-1 vote, a panel of judges on the U.S. Circuit Court of Appeals for the District of Columbia rejected the Obama administration’s argument that the problem was triggered by imprecise language in the complex law and that Congress had always intended to offer the subsidies nationwide to low- and middle-income people who bought insurance through one of the state or federal health exchanges created under the law.

OK, I'll have much more to say about today's Halbig decision this afternoon, but for the moment, let me just repost a press release, verbatim, from the campaign of Mark Totten, presumptive* Democratic nominee for Attorney General here in Michigan:

(*ok, technically he's not the nominee until after the MDP convention next month, but I'm pretty sure he's uncontested).

With all my stories about the requested premium increases in various states not living up to the "sky is falling" hype, several people have called attention to the fact that in New York State, it's not looking good:

ALBANY—New York insurance companies are looking to raise health insurance premiums by an average of 13 percent, according to proposed rates released by the state's Department of Financial Services on Wednesday.

The requests come from the 41 insurance companies operating in New York's insurance market. Last year, 16 insurers offered plans on the state's health exchange, which was created by the Affordable Care Act.

The six most popular plans on the state’s exchange requested double-digit increases in their premium rates for next year, with an average request of a 14.6 percent rate hike.

A couple of weeks ago there was much ado about a new Commonwealth Fund survey which found that nationally, the uninsured rate had been cut by 25% (from 20% down to 15%). Well, buried in that study was this bit about California specifically:

The percentage of uninsured Californians has been cut in half since the federal health law began expanding coverage nine months ago, according to a new national survey.

In September of 2013, 22 percent of California adults were uninsured. By last month, that number had fallen to just 11 percent, the biggest drop among the nation’s six largest states.

After yesterday's flood of updates, I'm taking a moment to give a shout-out to Chris Savage. He's currently running a fundraiser to help support Eclectablog, the Michigan-centric political site which deserves far more attention than this one. Eclectablog isn't primarily healthcare-related (although there are occasional ACA-related pieces by Amy Lynn Smith and LOLGOP from time to time), but it would mean a lot to me if readers of this site would lend a hand to that one.

Full disclosure: Not only is Chris a friend and colleague, he also happens to be one of my hosting clients, so in that sense this may be a bit self-serving.

Now, this is noteworthy because according to an earlier update, as of around a week earlier, the state had reported adding "between 2,000 - 3,000" exchange QHP enrollees between the end of open enrollment on 3/31 (WA did not offer an extension period) and May 27th; let's split the difference and call it 2,500. Add that to the official 3/31 total and you get around 166,500.

What accounts for the roughly 10,000 person difference? Well, the first number includes both enrollments and cancellations after the first month. Remember, Washington State only reports enrollments once the first month's premium has actually been paid, so these should be "clean" numbers.

WOW!! This article from last week is chock full of data-nuggety goodness, including the first solid updates out of Washington State in some time:

The share of Washingtonians going without health insurance has fallen by nearly 40 percent, thanks to factors put in play by the federal Affordable Care Act.

That’s the word from the state Office of the Insurance Commissioner, which estimates that the overall 970,000 of uninsured residents had fallen by 38 percent to about 600,000. That drops the uninsured rate to 8.65 percent of the state, down from about 14 percent, OIC spokeswoman Stephanie Marquis said Wednesday.

...OIC has said the individual market has grown to more than 327,000 – which was about 81,000 more insured people than were in the individual market on Oct. 1, the date that the Washington Health Benefit Exchange opened for enrollments for 2014 coverage. The individual market included 156,155 people buying private insurance policies through the exchange and 171,286 who bought policies outside the exchange.

Contributor deaconblues provides a very nice catch today: A story about Wisconsin's enrollment figures which gives all the tools necessary to calculate the state's total and paid QHP enrollments as well as the off-exchange total to boot...all without actually providing any of those numbers, which is kind of a neat trick!

Let's break it down:

Wisconsin’s Office of the Commissioner of Insurance has released information concerning the number of people that have acquired health insurance coverage as of June 1 of this year. The state’s Governor, Scott Walker, intends to cut the number of uninsured people throughout Wisconsin in half within the foreseeable future. According to state officials, the number of uninsured people in the state as of March of this year stood at 556,000.

Some 166,000 Wisconsin residents have purchased health insurance over the past several months, according to the Office of the Insurance Commissioner. Of these, some 134,000 people purchased coverage from the state’s health insurance exchange.

As I noted way back in October (seriously, I made a note of it at the bottom of the spreadsheet the very first week), the ACA situation in Guam, American Samoa, Puerto Rico, the U.S. Virgin Islands and the Northern Mariana Islands is, to put it mildly, kind of screwed up. Due to some massive oversights, they were stuck with some of the ACA's provisions (no denials for pre-existing conditions, having to accept everyone, etc.), but didn't get the other key provisions (no exchanges, no subsidies). As a result, it's been a bit of a mess.

Thankfully, the problem has been "solved", although not quite the way the Obama administration intended:

Guam and the four other American territories got some good news this week: they will no longer be held hostage by a byzantine set of Obamacare rules and regulations.

As deaconblues notes, a mixed bag. Scott Walker kicked 63,000 people off of Medicaid, of which 38,000 weren't able to receive coverage of any sort. On the plus side, over 97,000 additional people were added to Medicaid coverage.

So, if I'm reading this correctly, it sounds like Wisconsin's Medicaid program added around 160,000 people but lost 63,000 to get the net of +97K.

Coverage ended in April for 62,776 people who earn too much to remain on Medicaid; they had until June 1 to buy the federally subsidized insurance offered through the federal online marketplace where applicants can shop for plans.

The new DHS numbers show that 30 percent, or nearly 19,000 people, purchased a plan through the exchange by the June deadline. Nearly 5,900 more, or 9 percent, either became Medicaid-eligible and received coverage through the state's BadgerCare Plus program or were enrolled in both Medicaid and the exchange.

Montana's official 4/19 exchange QHP tally was 36,584, of which I estimate around 33,000 have actually paid their first month's premium. Since MT has not expanded Medicaid, and is a sparsely-populated state, I only have them pegged with around 5,000 Woodworker enrollees, for a total of around 38,000 people.

Considering that the Kaiser Family Foundation has estimated the "previously uninsured" rate at only around 57% nationally, it's actually quite impressive that the net reduction in Montana's uninsured is 30,000; that suggests that for this state at least, it's closer to perhaps 79%:

HELENA, Mont. (AP) — About 30,000 more Montana residents are enrolled in a health insurance plan than were before the Affordable Care Act enrollment period took place, state officials said Tuesday.

State Insurance Office Deputy CommissionerAdam Schafer told a legislative panel his office surveyed the state's largest insurance companies to learn whether the number of uninsured decreased after the federal health care overhaul.

The good news: While Maryland's enrollment numbers are still way below their expectations due primarily to a screwed-up exchange website, they're continuing to crank out smaller numbers of enrollees, and have now hit the 75K milestone:

Maryland enrolled about 75,000 people in private health plans, about half as many as the state initially aimed to sign up in private insurance plans. However, the state ended up enrolling about 300,000 people through Medicaid. The Connecticut health exchange technology was chosen largely because it was effective and preserves Medicaid enrollments.

The 300K Medicaid number is impressive, but I already have that number plugged in so no changes there.

On the down side, MD's move to an all-new exchange website platform (purchased from Connecticut), while a welcome move, will also require everyone who's receiving subsidies to re-enroll this November:

I posted about Colorado's June enrollments a couple of weeks ago, but that was a rounded number and apparently was mixing in SHOP enrollees with QHPs. The official report has been released, and the numbers are a bit worse than I thought (though still impressive for off-season enrollment): 136,605 QHPs and 2,373 SHOP enrollments.

Arizona may not be adding Medicaid expansion recipients at nearly the same rate as states like Michigan, West Virginia and Arkansas, but they're doing a pretty good job; AZ is now up to over 192K people, or about 41% of the estimated 469K uninsured individuals who are eligible for Medicaid:

During the month of June, 19,736 were added to AHCCCS in the Proposition 204 Restoration Category (0-100% FPL) and 4,771 were added to Adult Expansion category. To date, 192,268 Arizonans have been added since January. The total AHCCCS population now stands at 1,552,186.

Yeah, yeah, I know...it's a bit stupid to set up a Facebook page now instead of, say, back in October, November, December...but whatever. I was encouraged by the response at Netroots Nation 2014 that there's still enough interest to keep the site not just running but running robustly, so here you go: The official ACA Signups Facebook Page.

Also, while I'm at it, I've established a separate Twitter account just for ACA Signups. I mainly did this to prevent any imposters from doing so, since so many people are already following @charles_gaba for ACA updates, but I'll probably start cross-posting at @ACASignups as well if enough people start following it.

NOTE: Yes, I'm back from the Netroots Nation convention here in Detroit, and yes, I have a mountain of ACA submissions (along with actual paying client work) to catch up on. However, with the DC Circuit Court ruling expected to come out tomorrow, it behooved me to post this ASAP:

A couple of weeks ago I posted a 2nd story about the last (to my knowledge) major anti-ACA case winding its way through the federal court system: Halbig v. Burwell.

In a nutshell, the plaintiffs are arguing that the precise wording of the ACA allows the IRS to issue tax subsidies to people who enroll in QHPs using the state exchanges (NY, CA, KY, CT, etc.), but not to people who enroll through the federal exchange (ie, Healthcare.Gov). If the case survives all the way through to the SCOTUS (or if it survives the full DC Circuit Court and the SCOTUS refuses to look at it), then it would presumably mean that almost 5 million people (or more) who enrolled via HC.gov and qualified for subsidies (about 85% of them) would a) have those subsidies cut off and b) could theoretically have to pay back the subsidies that they already received, assuming the ruling was retroactive.

I know I said I wouldn't be posting during the Netroots Nation convention unless something significant happened. Well, thanks to the Kaiser Family Foundation, I've learned of a pretty important development. The state of Rhode Island just released their decision on the APPROVED insurance premium rates for Blue Cross Blue Shield in 2015. Check it out:

As you can see, BCBSRI asked for an average rate increase of 8.9%. The state insurance commissioner approved...4.5%.

Obviously this may not be typical of what will happen in other states or for other companies, but the point is made: the preliminary rate requests are just that: Preliminary. You can REQUEST anything; that doesn't mean you'll get it.

UPDATE: I've found the market share breakout for both companies (the third one is new to the exchange), and it looks like BCBSRI made up almost all of it (98%), so the weighted average looks to come in at around 4.3%.

As I mentioned the other day, I'll be attending the Netroots Nation conference here in Detroit for the next few days. On the one hand, this would seem to be the perfect event to post lots of blog updates. On the other hand, most of those updates require me to muck around with spreadsheets and whatnot, which I don't really feel like screwing with for the duration of the conference.

So, unless there's some really major ACA-related news which breaks between now and Sunday, I probably won't be posting anything until then. Please feel free to send updates, they just won't be posted until after the conference.

As far as I know, Kliff hasn't referenced ACA Signups since the open enrollment period ended, but she's still doing great work on the ACA over at Vox, and today is no exception. She wrote up a nice outline of 7 major anti-ACA attack points and how every one of them have been knocked down, one by one:

Until a few days ago, my predictions about how many people would enroll in Qualified Health Plans via the Affordable Care Act exchanges were, without being boastful, dead-on target.

I called the New Year's Eve total with 98.2% accuracy and Medicaid/CHIP determinations through 12/31 with 99.7% accuracy.

I was off by less than 0.02% at the end of January, and by less than 1% through the end of February.

I projected the 3/31 total to be 7.08 million; the final tally was "around" 7.1 million, and my call of 7.78 million as of 4/15 was off by somewhere between 0 - 2.75% (I'll never know for certain because the only official number given (8.02 million) was as of 4 days later).

However, I'm obviously not perfect at this, and if I misjudge a significant factor, my projections will be off accordingly.

Like many other Republican-run states, Texas not only refused to set up their own ACA exchange or expand Medicaid, the state government actively sought out to prevent people from enrolling, actually enacting absurdly strict "regulations" to prevent ACA Navigators from doing their job to help people learn about their rights and how to go through the process:

The navigators must register with the state, undergo a background check and fingerprinting, and complete 20 hours of additional training — beyond the 20 to 30 hours of federal training they've already received.

Hmmm...OK, first it was Hawaii with the QHP total actually going down from 6/28 through 7/05. Then Minnesota reported a huge drop-off in their off-season enrollment rate, from about 52 per day from April through the end of June to just 2 per day for the first 13 days of July.

Now we have Oregon's latest update. While the total QHP figure has grown by 1,092 over the past week, the paid QHP number has only gone up by...10. That's right: Just 10 in the past week, or just over 1 person per day...down from over 300 per day in the off season until now.

(As an aside, new Medicaid enrollments are also slowing down, with just another 290 people being added to the program).

Hmmm...Minnesota's exchange QHPs continue to grow, but the rate has plummetted over the past couple of weeks, dropping from 52 per day through the end of June to just 31 in the past 2 weeks. While I've been expecting the rate to slow down somewhat, this seems like an awfully large drop for such a short period of time.

Combine this with Hawaii, which reported an actual loss of QHPs and I'm starting to wonder if I've misunderstood how the state exchanges are reporting their numbers. It's possible that they're including people who drop their coverage after a few months as well as those who add coverage, which would result in the official tally holding relatively steady over time. I'll have to look into this...

Yesterday I posted an update from Michigan which touted the state meeting their 1st year Medicaid expansion enrollment target of 322K; today the official tally was updated again, with another 3,000 people being added:

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 326,167
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

We are teeming with excitement to announce that Nerdist is premiering “Weird Al” Yankovic’s first music video for his #8videos8days project. Feast your eyes on the video for “Tacky,” a wonderfully warped and wacky version of Pharrell’s hyper-bubbly mega-hit, “Happy.”

A couple of weeks ago, I posted an entry regarding the proposed rate change requests by the 17 insurance companies participating on Michigan's ACA exchange for 2015. The news at the time was a mixed bag, with some companies requesting rate increases of up to 18%, while others were requesting a reduction of their rates by 22%. Overall, according to the Detroit Free Press article, the average rate increase request is a mere 0.8%. Hooray!

Michigan Governor Rick Snyder doesn't have many things to be proud of, but this is one of them: He did help push the ACA's Medicaid expansion through the extremist GOP-controlled state legislature. In response, the Healthy Michigan program has now enrolled over 323,000 newly-qualified people in Medicaid & CHIP:

LANSING, Mich. – Gov. Rick Snyder today announced that after less than four months, enrollment for the Healthy Michigan Plan already has surpassed its first-year goal of 322,000.

As of today, July 10, Michigan has 323,022 Michigan residents enrolled in the program. The Healthy Michigan Plan extends health care benefits to a half-million low-income residents. Enrollment for the plan began April 1.

The press release mostly crows about reaching the "first year goal" of 322K people in only 14 weeks, but to me the more impressive achievement is hitting 64% of the total eligible population (500K) in that time.

With the unexpected addition of QHP updates from 2 Federal Exchange-based states over the weekend (West Virginia and New Mexico), I've updated the Off-Season QHP Projection spreadsheet again, and now have it sitting at a range of between 9,500 - 12,500 additional exchange-based QHPs per day, or 285K - 375K per month:

I've also made a slight modification as to how I'm distinguishing the upper & lower-bound numbers. Instead of simply dropping Oregon out of the mix, I'm instead using every state with post-4/19 data for the upper bound, and then taking 75% of that for the lower bound. This has the same overall effect but seems more sensible than singling out one particular state for being an outlier.

In any event, this revision suggests that the total 2014 exchange QHP total should end up between 10.0 - 10.6 million. Subtract 10% from that for non-payment and you have somewhere between 9.0 - 9.5 million paid QHPs.

Some good news (relatively speaking) on the Massachusetts front: As you'll recall, the state which inspired the ACA (ironically due to the program being spearheaded by then-Governor Mitt Romney), and which has been operating under their state-level version of the law smoothly for some years now, had an incredibly embarrassing misfire with their ACA-specific exchange website. After hobbling through the first enrollment period (and leaving over 200,000 residents in healthcare limbo as a result), it was determined that the existing site was such a mess that they had two choices: Either replace the existing software with an entirely new system, or drop the whole thing and move over to the Federal exchange as Oregon is doing.

Instead, Massachusetts decided to hedge their bets and pursue both: They've been working with a new vendor to rebuild their own exchange from scratch, while simultaneously arranging for a quick move to HC.gov just in case Plan A doesn't work out.

The good news is that so far, anyway, the new platform seems to be working out in early testing, though it's way too early to be sure of anything:

Wow! This editorial is fairly short but chock full of great up-to-date enrollment data: Exchange QHP enrollment has risen exactly 6,000 people since April 19 (an increase of over 30%); the Medicaid expansion tally is up by 4,556 to 132,556 people (almost 93% of the total eligible), and the overall uninsured rate has plunged from 17% to just 6.6%...all in less than 10 months. Amazing.

President Barack Obama’s Affordable Care Act is a superb success in West Virginia, according to new reports.

A total of 132,556 lower-income West Virginians have gained coverage through the Medicaid expansion approved by Gov. Earl Ray Tomblin. An additional 25,856 were able to enroll in subsidized private insurance plans. And about 18,000 young adults were allowed to remain covered by their parents’ policies until age 26.

That’s more than 176,000 Mountain State people who gained the ability to visit a doctor, get prescriptions filled or receive hospital care. Hurrah. It’s a big advance for compassion and humane values. Everyone should have access to medical treatment, and nobody should be left out.

In addition, however, I've also done something which has been on my mind for awhile now: For the first time, I've removed the UNPAID Exchange QHP section from the graph completely.In addition, I've knocked the "Paid" percent down one more notch to 89%--not because I've changed my mind about the eventual paid percentage hitting 90%, but because at any given time the most recent enrollees (from the past couple of months) will fall below that threshold, meaning the overall paid percentage will be slightly lower.

OK, I just received the report itself, so it'll take awhile to slog through the numbers, but here's the chief takeaways:

Medicaid enrollment continues to increase all across the country, especially in those states that have expanded their Medicaid programs under the Affordable Care Act.

As of the end of May, 6.7 million more individuals were enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) as compared to the baseline period from July through September 2013, an increase of 11.4 percent. That includes more than 920,000 additional people enrolled in May as compared to April in the 48 states and the District of Columbia that reported data.

As we’ve seen for months, growth was more pronounced in 26 states (including the District of Columbia) that had adopted and implemented the Medicaid expansion by the end of May. Enrollment in those states rose by 17 percent, while states that have not expanded reported only a 3 percent increase.

Oregon continues to rack up impressive QHP numbers, although their daily average is definitely slowing down as we move farther from their "extended-extension period". Even so, their net enrollments are still up another 1,258 since 6/24, while Medicaid enrollment has gone up just 1,221. My suspicion for the Medicaid enrollment drop-off (also noted by contributor deaconblues) is that they've simply run out of Medicaid-eligible people in the state...which makes sense seeing how they've added 355K people to the program since January (227K via the exchange + another 128K via their "fast track" program), when the Kaiser Family Foundation estimated that there were only 260,000 uninsured people even eligible for Medicaid to begin with!

Contrary to the conservative meme that everything in the Patient Protection and Affordable Care Act (ACA) is an unprecedented overreach of federal power, the ACA contraceptives mandate was patterned on longstanding state “insurance-equity” laws. Such laws promote the health of women, children and families by assuring access to prescription contraceptives. Though not superseded by the decision handed down by the Supreme Court in the Hobby Lobby case, these state laws never actually pertained to Hobby Lobby or any other large employer with pockets deep enough to avoid state-regulated insurance products altogether by self insuring.

A few days ago, several people sent me a link to this story from the Philadelphia Inquirer which discussed the impact of the ACA on Medicaid enrollment in the 26 states which expanded the program vs. the 24 which haven't done so (including Pennsylvania), and the positive impact it would have on PA's uninsured rate if they were to do so.

However, the following passage seemed rather strange to me, and I didn't want to post anything about it until I cleared up the mystery:

Pennsylvania and the 23 other states that haven't expanded Medicaid have signed up fewer than three million people for the program. That's in sharp contrast to the almost 10 million people enrolled by the 26 states and District of Columbia that expanded Medicaid when the marketplace opened November.

Hot on the heels of this morning's Commonwealth Study survey, which pegs the reduction of the number of uninsured adults at 5% (around 9.5 million, plus perhaps 2.5 million children under 18, for a total reduction of around 12 million) comes another study by the Urban Institute, which gives a slightly smaller reduction (4% of all adults nationally, or around 8 million...or around 10.5 million or so if you add children in).

The Commonwealth Fund study which is causing such a buzz today contains a lot of interesting data points. The one which is the most bothersome is this:

It's not terribly surprising that expansion states saw their uninsured rate drop more than non-expansion states, but this seems like too much of a difference (11% vs. 2%)...until you remember that this only applies to people in poverty...that is to say, only the Medicaid/CHIP data is relevant here, as noted by Jeffrey Young in his Huffington Post piece.

A wonderful new survey by the Commonwealth Fund was released today, chock full of all sorts of data-nuggety goodness:

We’ve known for a few months now that lots of people signed up for health insurance this year in new marketplaces. A new survey shows that the people who did so are also pretty happy with their purchases.

The survey, from the Commonwealth Fund, a research group, came to similar conclusions as other surveys about the expansion of health insurance. It found that about 15 percent of adults younger than 65 now lack health insurance, down from 20 percent before the Affordable Care Act rolled out in January.

What was more surprising is that people who got the new coverage were generally happy with the product. Overall, 73 percent of people who bought health plans and 87 percent of those who signed up for Medicaid said they were somewhat or very satisfied with their new health insurance. Seventy-four percent of newly insured Republicans liked their plans. Even 77 percent of people who had insurance before — including members of the much-publicized group whose plans got canceled last year — were happy with their new coverage.

I'm sure most of you have already seen this photo from President Obama's "border crisis" meeting with Texas Governor Rick Perry yesterday.

While I find Perry's "Grumpy Cat / Just Swallowed a Bug" face to be as hilarious as anyone else (made even better by Pres. Obama's laughter), there's something else in this photo which I find a bit strange: The name tags.

As an aside, according to KFF, there were around 259,000 uninsured Minnesota residents eligible for Medicaid (pre-ACA + expansion) prior to January 1st. Assuming none of the 205,896 people who enrolled via the MNSure exchange were renewals (and they shouldn't be, according to the prior monthly CMS reports), that suggests that MN has now enrolled nearly 80% of all eligible residents who weren't already on Medicaid, leaving just 52,000 people to go, give or take.

Investor's Business Daily published a story today by someone named John Merline which references an Inspector General report stating that the enrollment data from HC.gov isn't being reconciled properly with the data from the insurance companies on the federal exchange, something which is apparently required by the ACA law itself. Now, if this is true then that's certainly an issue which needs to be resolved. However, my problem with the article comes a bit further down, where my site and data are referenced repeatedly:

The administration hasn't released updated enrollment numbers since May, which covered the entire open enrollment period at the federal exchange. An update would shed light on how many are keeping up with premium payments.

But 15 states have separately reported paid enrollment numbers, and according to data compiled by ACASignups.net, paid enrollment is 322,000 fewer than the last official White House count — which means nearly 13% of those counted haven't paid their premiums.

No, I don't have a panel; I'm not a guest speaker or anything along those lines, just a regular attendee, but if any site regulars plan on attending, I'd love to meet you. I'll most likely be found either hanging out with the Motor City Kossacks crowd or just wandering around; I don't have any particular agenda.

The growth of Michigan's ACA Medicaid expansion program is finally slowing down, but they've still tacked on another 3,000 or so people in the past week, bringing enrollment up to 64% of the total eligible to enroll:

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 317,931
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

This Just In: From the Paul Gallo Show, the Mississippi Insurance Dept. and Cover Mississippi: One of the 2 insurance companies operating on the ACA exchange in Mississippi plans on cutting their rates by a whopping 25%!

The caveat is that we still don't know what the other company's rate plans are, nor do I know what that 25% rate cut was in the first place, but this is still excellent news:

In the interest of caution, however, I'm still keeping my "official" projection a bit lower still, at around 8,000 per day (though this is up from the 7,000/day I had been using until now). This translates to around 616,000 new QHP enrollments as of yesterday (77 days out), bringing the estimated total to a bit over 8.6 million overall.

When I last checked in on the District of Columbia exchange, they were reporting 11,582 exchange QHPs as of June 11...868 higher than the last official HHS tally as of 4/19. That means that they had been averaging around 16 new QHPs per day at that time.

Well, today they issued another update: As of July 1st, the total is up to 12,333. This is another 751 higher, bringing the overall off-season average up to 22 per day. That's right: Just like in Colorado, DC's QHP off-season enrollment rate is actually increasing as we move farther away from 4/19...at least so far.

So, what does this mean for the national trend? Well, the numbers are too small to impact the overall range, of course, but so far both Colorado and DC's latest updates have only inched the trend upwards; it now sits at a lower bound of around 9,000/day and an upper bound of 12,000 per day.

As always, I continue to be cautious in my actual tally prediction, though I've moved this up from 7K/day to 8K/day; if the lower bound reaches 10K, I'll bump my "official" projection up to 9K and so on.

OLYMPIA, Wash. – Washington Healthplanfinder today announced a limited special enrollment period for Washington state residents whose same-sex domestic partnerships were recently converted to marriages on June 30. The 60-day enrollment window provides these couples with a unique opportunity to enroll in a Qualified Health Plan before the next open enrollment period that starts on Nov. 15, 2014 for coverage beginning in 2015.

A related article has the number of people impacted (3,600 couples, or about 7,200 people total):

Washington’s health benefit exchange is opening up a 60-day special enrollment period for couples in same-sex domestic partnerships that were recently converted to marriages.

On June 30, most state-registered domestic partnerships were converted to marriage automatically in Washington. This affected an estimated 3,600 gay and lesbian couples in the state.

This one is a bit squirrelly to suss out, and I'm not sure that I've done so correctly, so bear with me. According to the (very short) article:

MONTGOMERY, Ala. (AP) — State officials say Alabama Medicaid's monthly enrollment has topped 1 million for the first time.

Officials said Thursday that a review of data for the first five months of the year show the milestone happened in February. Officials attribute the increase to a federally required transfer of children from the state's All Kids program and changes in how Medicaid eligibility is determined. Officials say the numbers also reflect the first enrollment of individuals who applied for coverage through the federal health exchange under the federal Affordable Care Act.

As of the previous update (5/31), Colorado was averaging around 177 QHP enrollees per day in the post-open enrollment period (7,413 / 42 days). With this latest update (dated June 24), they've actually increased this average slightly (4,185 / 23 = 182/day), for an overall off-season average of 178 per day:

The number of new enrollees in private health insurance through the state exchange, Connect for Health Colorado, continues to inch upward by about a couple hundred a day — and now stands at 137,000, officials said Tuesday.

Although open enrollment officially ended March 31 with 118,000 signups, it unofficially ended at 124,000 in mid-April as people who started before the deadline finally finished the process.

This stability makes me more confident of my 9K - 12K/day off-season estimate, since the late April/early May enrollments might otherwsie have just been chalked up to unprocessed leftovers from the enrollment extension period. However, the rate increasing (if only slightly) suggests that for Colorado, at least, the off-season rate seems to be pretty stable.

I wrote a week or so ago about the Halbig v. Burwell (formerly Halbig v. Sebelius) case currently pending in the D.C. Circuit Court of Appeals. The short version is that there's a challenge to the IRS doling out tax credits to the 5 million people or so who enrolled in and qualified via Healthcare.gov (the Federal exchange) across 36 states, based on the wording of one particular section of the Affordable Care Act which supposedly refers to subsidies only being allowed for the exchanges run by the state.

At issue is Section 1401, which states:

The premium assistance amount determined under this subsection with respect to any coverage month is the amount equal to the lesser of—

(A) the monthly premiums for such month for 1 or more qualified health plans offered in the individual market within a State which cover the taxpayer, the taxpayer's spouse, or any dependent (as defined in section 152) of the taxpayer and which were enrolled in through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act, or...

Since the SCOTUS's Burwell v. Hobby Lobby decision, a lot of people have been pointing out the Pandora's Box that this could potentially open for company owners to start violating civil rights laws willy-nilly, all based on whatever their particular flavor of religion happens to be.

How would conservatives and their agents respond if a company with Islamic beliefs (however defined) decided to impose its religious values on white, Christian, American employees?

Sharia hysteria would spread in such a way as to make the present day-to-day Islamophobia of the Right-wing echo chamber appear benign and muted by comparison.

What if a Black cultural nationalist organization such as the Nation of Islam or the Black Israelites claimed that they possessed a "religious freedom" to actively discriminate against white people in the workplace or elsewhere?

The great irony here is that this accurate and helpful data point is provided by a very anti-ACA story, but whatever:

A total of 243,230 Ohioans have already been added to the state’s Medicaid rolls under the Obamacare expansion implemented by Republican Governor John Kasich this January.

Based on the Ohio Department of Medicaid’s May caseload report released last week, enrollment under the expansion was 232,711 in April — not the 184,671 reported last month.

The March enrollment figure was also revised dramatically upward last week, to 208,213 from the 171,910 reported last month. In April, the Ohio Department of Medicaid estimated that March enrollment for those eligible under Obamacare was 106,238.

As regular visitors to this site know, my own "estimated total, all sources" number shown on The Graph currently ranges between 24 - 29 million people...but is in turn broken down into different types of enrollments, with different caveats, disclaimers and so forth depending on what criteria you're trying to measure.

In the case of Sebelius's quote, Kessler is attempting to parse 3 specific points: The number (22 million); the description ("affordable coverage") and the credit ("thanks to the ACA").

ATLANTA ‑ UnitedHealthcare, Coventry, Cigna and Time Insurance Company have each submitted plans with the state to offer insurance in the federally run health care exchange in Georgia next year.

They join the five holdovers from this year’s exchange that are also submitting rates for review: Alliant Health Plans, Blue Cross and Blue Shield of Georgia, Humana, Kaiser Permanente, and Peach State Health Plans.

Also, you may recall a nice graph by Dan Diamond from a couple of weeks back showing the states which are increasing their exchange competition for 2015; I've crudely updated it with new competition data from 4 additional states: Connecticut, Maryland, North Carolina and Georgia (plus one more added to Kentucky since he posted it):

Not that any of this will appease anti-vaxxers any more than solid, comprehensive, overwhelming scientific evidence will get Climate Change Deniers, Obama Birthers, 9/11 Truthers or the Flat Earth Society to let it go already, but I'm presenting it here anyway:

The researchers, from the RAND Corporation, searched databases of scientific literature for vaccine-related studies, turning up 20 ,478 in total. This included studies of childhood vaccines — such as DTaP (diphtheria, tetanus and acellular pertussis), hepatitis A, hepatitis B, influenza, meningococcal, MMR (measles, mumps and rubella), and varicella — as well as adult vaccines such as flu shots.

Then they boiled this number down to 166 controlled studies — the gold standard of scientific research — in order to directly compare the effects of being vaccinated with the effects of getting a placebo injection or no vaccination.

CRUCIALLY, THEY FOUND ABSOLUTELY NO LINK BETWEEN CHILDHOOD VACCINES AND AUTISM SPECTRUM DISORDERS

With the addition of some new enrollment data out of Kentucky and Minnesota, I've updated the Off Season QHP Enrollment chart. Note that the available data only includes states representing about 8% of the total enrollments nationally, and even some of those are only updated through early May, so the numbers will no doubt bounce around a lot as fresh numbers come in.

I plan on only updating both the Off Season chart as well as The Graph on the 1st and 15th of each month, unless there's major new data which comes in (like, say, from CoveredCA...hint, hint...).

Visit the link for a pretty cool rollover county-by-county map showing ACA exchange enrollments in New York State:

Last week, the state's health department released demographic information on who used New York's new health insurance exchange to enroll in a health insurance plan.

The data showed how many people across New York signed up for private health insurance plans, enrolled in Medicaid and took advantage of Children's Health Plus.

In total, nearly 1 million people got health insurance coverage through New York State of Health, or about 5 percent of the state's population. The exchanges were created by the Affordable Care Act.

Capital broke that down by county: We found Queens County had the highest percentage (6.78) of its population enroll while Madison County (2.86) had the lowest. But in Madison about half the people who enrolled signed up for a Medicaid plan while half signed up for private insurance. In Queens, twice as many people signed up for Medicaid compared to a private insurance plan.

The cognitive dissonance of the Republican Party (otherwise known as "hypocrisy" or simply "chutzpah" in layman's terms) is amazing.

Remember the complete FAIL of the Healthcare.gov launch last October? Remember how Republicans were screaming from the hills about a Canadian firm (instead of a U.S. based one) winning the largest site development contract, and then proceeding to utterly botch the job? Remember how the same company, CGI of Montreal, also dropped the ball in several of the state-run exchanges, including Hawaii, Vermont, and most infamously, Massachusetts???

Well, guess what story just broke here in Michigan?

LANSING, MI -- Michigan has awarded a $90 million contract to the Canadian tech company that built HealthCare.gov despite rollout problems with the federal website and a lower bid from another company.